Dr. Dev K. Mishra, who has served as team doctor at the professional, national team, college and high school level, is the founder of SidelineSportsDoc.com. We asked Dr. Mishra about injury trends he has observed in youth soccer; whether there are different injury patterns between boys and girls; and what coaches can do to help keep their players healthy ...

SOCCER AMERICA: What trends have you seen in the past years in youth soccer injuries?

DR. DEV MISHRA: There’s two things that we’ve seen that have really risen dramatically.

One is that it seems that for whatever reason we’re seeing a much larger number of overuse injuries than we used to see even 10 years ago.

These would be things like tendonitis, stress fractures, things that result from repetitive usage of an extremity. That’s No. 1.

No. 2. We’re seeing a rise in certain traumatic injuries at a much earlier age than we used to. For soccer players it’s principally ACL tears.

There seem to be many factors involved in that. Whether it’s more kids playing, different style of play, different surface, or mechanical issues like muscle weakness.

But we’re seeing ACL tears in children as young as 12 and 13 years old – which used to be really quite rare 15 years ago.

SA: Are there different injury patterns for boys and girls?

DR. MISHRA: Girls tend to become physically mature earlier than boys do and certain injuries such as ACL tears happen at a younger age in girls than they do in boys.

We see adult-type injuries a little earlier for girls than we do for boys.

There’s also growing, very solid evidence that shows that girls respond differently to a concussion than a boy does. Girls tend to have symptoms that last longer and perhaps are a little more severe than one would see in a boy. There’s some strong scientific evidence of that coming out of the University of Pittsburgh.

SA: For years there have been reports of higher rates of ACL injuries in females. What should coaches do with this in mind?

DR. MISHRA: There’s a lot of effort in trying to improve training for girls to reduce ACL injuries.

Dr. Bert Mandelbaum’s group has been key in developing some of those methods. He and physiotherapist Holly Silvers have done a great job of identifying a simple warm-up that helps to improve the landing characteristics when you’re landing from a jump, and improving the mechanical ability to cut and pivot.

And they’ve shown that they do have reductions in ACL injury rates for teams that follow these protocols. (Editor’s note: For more on the Prevent injury, Enhance Performance (PEP) Program, click HERE.)

SA: What else can coaches do to help prevent injuries?

DR. MISHRA: Good training courses should include in their training age-specific methods that help coaches recognize and provide basic management for injuries.

As the kids get older and into adolescence there’s more of an emphasis on proper warm-up, flexibility, jump training, and other preventive measures.

Early on, the game should really be about fun and less about tactical awareness. It’s amazing that when we take tactical awareness and that type of thing out of the game -- and it becomes more play than game -- we see far fewer injuries than we do otherwise in a structured environment.

SA: How can coaches prepare to respond when injuries do happen?

DR. MISHRA: Coaches should use whatever resources are available to educate themselves about injury management .

Our premise, with SidelineSportsDoc.com, is to teach people a method they can use every time. Learn how to take care of the six to eight key injuries that happen. They’re going to be a little different for soccer than they are for baseball and hockey.

If you have resources available in your local community, take advantage of them. Perhaps your club has an injury management curriculum as part of your coaching certification course. Make yourself aware of a method and make yourself aware of the most common injuries, how to look for the red flags and manage that properly on the sidelines. Knowing those basic things will allow a coach to respond with confidence when an injury occurs.

(Dev K. Mishra, the founder of SidelineSportsDoc.com, is an orthopedic surgeon in private practice, Burlingame, Calif. He is a member of the team physician pool with the U.S. Soccer Federation and has served as team physician at the University of California, Berkeley.) (Mike Woitalla, the executive editor of Soccer America, coaches youth soccer for Rockridge SC/East Bay United in Oakland, Calif. His youth soccer articles are archived at YouthSoccerFun.com.)

"..see far fewer injuries than we do otherwise in a structured environment.."
how is that measured exactly?
The obvious answer is that the higher level players have many more hours on the field behind them.
We need better research to focus on female soccer. There is presently new, very serious research into using a slightly smaller soccer ball for women. Results so far are extremely promising. Enough so that the danish, German, Swedish and Scottish Soccer Associations are looking into it, and FIFA has become involved.
Present research has shown that using that smaller ball, reduces wear and tear injuries. The side effect? a more entertaining game (faster, longer kicks and throw-ins and tactically advanced).
The #5 is simply too larger and too heavy for girls. Sound crazy?
Not to the above. They are on board.
This ball (made by Umbro) has been researched for the past 2 years (yes, real unprecedented research) in Denmark. They have come up with a soccer ball with measurements made for girls/women.
Sounds crazy - unless you already know that (1) WNBA plays with a smaller ball than the NBA. (2) men are stronger, faster and bigger than women (I did not say tougher, feistier og grittier!) and (3) every sport has been adjusted for the female in some way - except soccer. And if it were not for the injury discrepancies, this discussion would not be.
To dispute a smaller ball for women, you need to first dispute any of the above.
The ball lends women no advantages, it simply levels the playing field. Women can do with this ball what men do with a #5. Imagine that...
See: http://www.sensationalfootball.dk/
Take the time to read about it.
It is a win-win no-brainer.

Interesting Story from the Washington Post
Study shows boys and girls may present different types of symptoms from sports-related concussions
By Alan Siegel
Special to The Washington Post
Wednesday, December 8, 2010; 12:03 AM
According to a study presented Tuesday on Capitol Hill, boys and girls may present different types of symptoms after suffering a sport-related concussion.
Data collected from 100 American high schools during the 2005-06 and 2006-07 academic years showed that while recuperation time is similar for both sexes, males reported more cognitive symptoms (feeling "slowed down" or "in a fog," difficulty concentrating, difficulty remembering) while females reported more neurobehavioral (sleeping more than usual, drowsiness, fatigue, nervousness) and somatic (headache, nausea, sensitivity to light and noise, and balance problems) symptoms.
R. Dawn Comstock, one of the study's authors, presented the findings at the National Athletic Trainers' Association's Youth Sports Safety Summit at the Cannon House Office Building. The study will be published in the January issue of the Journal of Athletic Training.
"We don't know if these findings represent a true biophysiological difference," said Comstock, an associate professor at the Ohio State University College of Medicine. "Are girls really experiencing different symptoms? . . . Or is there a sociocultural component? Is it a lot harder for a football player who's forgetting the plays to hide that from his coach than it for a girls' basketball player to hide the fact that the band in the gym is causing real problems with noise sensitivity?"
Comstock said, parents, coaches, athletic trainers and physicians should be aware that a football player and a girls' soccer player may not present - or at least verbalize - concussion symptoms the same way.
According to the study, "Without adequate symptom assessment, the neurobehavioral or somatic symptoms more commonly described by females may be more easily missed or attributed to other conditions, such as stress depression or anxiety"
Athletes from nine sports - football, boys' and girls' soccer, boys' and girls' basketball, wrestling, volleyball, baseball and softball - were represented in the study. More than 800 concussions were reported (610 males, 202 females).
"You have to rely on these self-reports from student-athletes. A concussion's not like a broken leg, where we can see a kid limping and take an X-ray," Comstock said. "Girls may be more willing to report some of these symptoms that boys may try to hide. Or we may still be a little protective of girls in our society. Coaches, parents, may be more on the look out for symptoms in girls."

I like the article, but you lost me on one section: "Early on, the game should really be about fun and less about tactical awareness". Yes, but I don't think fun and structured training are mutually exclusive, and structure I don't think leads to injury. In fact, in our U10-U12 boys academy this season, we had a broken arm and a fracture in a foot during the "unstructured" scrimmage games at the end of practice, as well as sprains in ankles and knees. I can trace the issue to hard challenges/tackles that the boys engage in during the more unstructured training - they take it to each other! When we play indoor in the winter, I haven't seen any serious injuries - and of course, you can't leave your feet on a challenge by rule in indoor, and also we use a size 3 in indoor and size 4 outdoors, the 3 is great training. So at least for the age I'm involved in, I would modify it a little and say "the game should not stress tactical awareness, it should focus on the player becoming comfortable with the ball, and learning defensive techniques that do not involve leaving your feet or using extended arms to leverage an opponent." May sound corny, but American youth players need to love the ball first, and the tactics and physicality of the game can be introduced at an older age. Good stuff though, I'll add your link to our academy web site.